An Accurate Cancer Incidence in Barrett's Esophagus: A Best Estimate Using Published Data and Modeling
An Accurate Cancer Incidence in Barrett's Esophagus: A Best Estimate Using Published Data and Modeling
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DOI：
10.1053/j.gastro.2015.04.045
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发表时间：
2015-09-01
期刊：
影响因子：
29.4
通讯作者：
van Ballegooijen, Marjolein
中科院分区：
文献类型：
--
作者：
Kroep, Sonja;Lansdorp-Vogelaar, Iris;van Ballegooijen, Marjolein
背景与目标：已发表的对巴雷特食管（BE）进展为食管腺癌（EAC）的速度的估计各不相同。我们使用模拟建模来协调已发表的数据，并更准确地估计BE患者中EAC的发病率。方法：我们校准了ERASMUS/UW模型（荷兰鹿特丹伊拉斯谟医学中心和华盛顿大学西雅图的合作），以匹配基于人群的研究中0.18%的年进展率。然后，该模型被用于模拟前瞻性研究的设计，引入更多的内窥镜监测。我们使用该模型预测两种类型研究和不同随访期的进展率，并将预测率与已发表的数据进行比较。研究结果：在前5年的随访中，该模型再现了基于人群的研究中观察到的0.19%的平均年进展率;在前瞻性设计的研究中，相同的疾病模型预测了0.36%的年进展率（在已发表的文章中报告了0.41%）。20年后，这些比率每年增加到0.63%至0.65%，相当于9.1%至9.5%的累积癌症发病率。在这些时期之间，两种研究设计的进展率之间的差异从91%降至5%。结论：在诊断后的前5年，从BE进展为EAC的速率可能更接近基于人群的研究报告的较低估计值，而不是前瞻性研究报告的较高估计值，其中EAC通过监测检测。临床医生应该利用这些信息向患者解释如果不采取措施的短期和长期风险，然后讨论监测的风险和益处。
BACKGROUND & AIMS: Published estimates for the rate of progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) vary. We used simulation modeling to reconcile published data and more accurately estimate the incidence of EAC among people with BE. METHODS: We calibrated the ERASMUS/UW model (a collaboration between Erasmus Medical Center, Rotterdam, the Netherlands and the University of Washington, Seattle) for EAC to match the 0.18% annual rate of progression from population-based studies. This model was then used to simulate the design of prospective studies, introducing more endoscopic surveillance. We used the model to predict rates of progression for both types of studies and for different periods of follow-up, and compared the predicted rates with published data. RESULTS: For the first 5 years of follow-up, the model reproduced the 0.19% mean annual rate of progression observed in population-based studies; the same disease model predicted a 0.36% annual rate of progression in studies with a prospective design (0.41% reported in published articles). After 20 years, these rates each increased to 0.63% to 0.65% annually, corresponding with a 9.1% to 9.5% cumulative cancer incidence. Between these periods, the difference between the progression rates of both study designs decreased from 91% to 5%. CONCLUSIONS: In the first 5 years after diagnosis, the rate of progression from BE to EAC is likely to more closely approximate the lower estimates reported from population-based studies than the higher estimates reported from prospective studies in which EAC is detected by surveillance. Clinicians should use this information to explain to patients their short-term and long-term risks if no action is taken, and then discuss the risks and benefits of surveillance.